UNITING PHYSICIANS & PATIENTS AS A VOICE IN HEALTH CARE
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The route to assuming the mantle of medical authority is a familiar one: the weeding-out process and survival of pre-medical studies, the plodding discipline of medical school, and the special expertise of post-graduate medical education all prepare the budding doctor to be adept at making diagnoses and rendering treatments. In the metamorphosis to medical professionalism, doctors may gradually come to view patients as a drag on treatment adherence; their individual wants and peculiarities are seen as psychological obstacles to optimal treatment outcomes. So, there are separate worlds of doctors and of patients.
But what happens when those worlds intersect—when the doctor is a patient? It is well known that physicians frequently have difficulty accepting the patient role for themselves and following recommendations and guidelines for care they recommend to their patients. Yet, arguably, public safety may be at issue when physicians don’t seek appropriate medical care or fail to follow through on prescribed treatment. This is particularly true for treatment of disorders related to mood and cognition—depression, drug addiction, alcoholism, and dementia.
These maladies affect physicians to at least the same degree as the general population; indeed, a recent study found that the chances of dying by suicide are about 70 percent higher for male physicians than for men in the general population, and between 250 percent and 400 percent higher for female physicians than other women (T. Hampton, JAMA, 2005, 394:1189–1191). Untreated depression in physicians is such a serious concern that American Foundation for Suicide Prevention issued a consensus statement in 2003 stressing the need to change professional attitudes and institutional policies to encourage physicians to seek help when needed.
Why do physicians resist medical treatment, especially for mental and substance use conditions? To understand this, we must look at a number of special issues for doctors in addressing their own health care needs:
Attitudes toward seeking care. Doctors strive to avoid shame and appearing weak to their patients and medical colleagues, an attitude that is reinforced by their medical training and acculturation. In addition, doctors are aware of medical uncertainty in predicting the outcomes of a given medical condition, and this awareness may contribute to delaying establishing a diagnosis for themselves. Also, they are used to being in charge of diagnosis and recommending and evaluating courses of treatment. So, when doctors are ill, they want to maintain control of the medical decision-making process.
Perhaps the biggest obstacle for physicians who need professional help has to do with trust, which is crucial to all healthy physician-patient relationships. Trust is based on the expectation that the treating doctor will remain engaged as the physician-patient's advocate in the ongoing work of diagnosing illness, making recommendations for appropriate care, and negotiating and implementing effective treatment strategies. Too many doctors seem to rule out this kind of physician-patient relationship for themselves because of the additional complexity that colleagues treating colleagues introduce into the relationship.
Attitudes of physician colleagues. Like most patients, physicians ask the question, "What would you do, doctor, if you were in my shoes?" But unlike non-physician patients, they are concerned that their treating doctors will treat them deferentially or abandon them as patients if they share their weaknesses, self-doubts, or secrets with a colleague.
Reporting requirements. Doctors may avoid seeking medical or psychiatric care because of legal obligations for physicians and health care professionals to report impaired doctors to the state. Because of the need to protect patients and the public, physicians and other health care personnel in Minnesota are required by law to report professional colleagues to their respective licensing boards if they suspect impairment or unprofessional conduct with patients.
Attitudes of health systems. The culture of the health care system in which a physician practices may create a barrier to seeking treatment for mental or substance abuse problems. Increasingly, physicians are employees of large clinic corporations, and as such, they fear being viewed as disposable when perceived by the corporation as unproductive or a liability to the clinic's reputation.
Medical insurance and payment matters. Health insurance plans that limit physicians'' access to treating physicians may pose barriers to getting treatment. For example, physicians whose access to medical care is restricted to physicians in their medical facility or insurance plan may be reluctant to seek in-house treatment for mental health conditions. In addition, they are rightly concerned about issues of privacy and confidentiality, as they know that medical and claims data may be passed on rather easily to other parties.
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